Willingness to Bone Allograft Donation and Transplantation in Sub-Saharan Africa: A Multi-Country Cross- Sectional Study

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Bone is the second most frequently transplanted human tissue worldwide, with 2.2 million grafts performed annually. In sub-Saharan Africa, donor and recipient consent remains uncertain due to diverse cultural, religious, and socioeconomic contexts. This study assessed public attitudes toward bone allograft donation and transplantation in Cameroon, Côte d’Ivoire, and the Democratic Republic of Congo to support the planning and implementation of bone banks. Methods. A multicountry cross-sectional survey was conducted between January and December 2024. Six hundred adults (200 per country) were recruited through stratified convenience sampling in urban and rural settings. After informed consent, participants completed an interviewer-administered questionnaire capturing sociodemographic data, willingness to donate and receive bone allografts, and reasons for refusal. Descriptive statistics, univariate and multivariate logistic regression identified predictors of willingness. Results. The cohort (mean age 36.2 years) reported a willingness to donate of 72.5% and transplantation acceptance of 72.8%. Refusal for donation was mainly linked to philosophical or spiritual beliefs, fear of trafficking, and remuneration request. Multivariate analysis showed that country of residence, religion, and occupation independently predicted donation, while acceptance was influenced by country and religion. Conclusion. Willingness to donate and receive bone allografts in sub-Saharan Africa is relatively high and comparable to high-income regions, though heterogeneity exists between countries. Key barriers include religious convictions, mistrust of health systems, and socioeconomic vulnerabilities. Establishing bone banks will require culturally sensitive education, transparent governance, and community engagement to transform willingness into effective donation practices. Bone allograft Tissue donation transplantation consent Sub-Saharan Africa Bone banks Figures Figure 1 Figure 2 Background Various infectious, neoplastic, degenerative or complex traumatic conditions of the musculoskeletal system can lead to critical bone loss during their course [ 10 ]. Management often requires the integration of bone defect reconstruction techniques into the therapeutic strategy. Bone is therefore the second most frequently transplanted human tissue worldwide, with 2.2 million bone grafts being performed each year [ 25 ]. However, any initiative aimed at acquiring and/or using bone allografts relies on an essential prerequisite: donor and/or the receiver consent. Such consent may be influenced by diverse cultural, philosophical, and spiritual beliefs [ 16 , 23 , 24 , 7 ]. Sub-Saharan Africa is characterized by considerable ethnic and cultural diversity, coupled with heterogeneous philosophical and religious perspectives, as well as significant discrepancies in terms of education and financial income [ 9 , 11 , 12 ]. The perception of the human body is therefore very variable from one area to another [ 1 ]. Consequently, the attitudes of populations in this region toward bone allograft donation remain difficult to predict. This study aims to lay the groundwork for the creation of bone banking units in Cameroon, Democratic Republic of Congo and Côte d’Ivoire, by characterizing the profile of potential donors within this multicultural context, taking into account local beliefs and practices. It also seeks to identify potential causes of refusal, which could serve as focal points for awareness campaigns designed to increase public acceptance. Methods This cross-sectional survey was conducted from January to December 2024 simultaneously in three sub-Saharan African countries: Democratic Republic of Congo (DRC), Cameroon, and Republic of Côte d’Ivoire (CIV). The study was designed to assess public perceptions and willingness to donate or receive bone allografts in the context of hip replacement surgery. A total of 600 participants were enrolled, with 200 from each country Participants were recruited using a stratified convenience sampling approach. Strata were defined by country, setting (urban vs. rural), and recruitment site (hospitals, marketplaces, universities, and community gathering points) to capture socio-demographic diversity. Within each stratum, individuals who met eligibility criteria and consented to participate were enrolled consecutively until the target sample size of 200 per country was achieved. Eligible participants were adults aged ≥ 18 years who were residents of the study area and able to provide informed consent. Individuals with cognitive impairment preventing questionnaire comprehension, as well as non-residents or visitors, were excluded. Non-responses and refusals were recorded and replaced. The response rate was calculated as the number of completed questionnaires divided by the number of eligible individuals approached (Fig. 1 ). Trained interviewers approached eligible participants and provided them with an information sheet describing a hypothetical scenario of hip replacement surgery. Following the provision of written informed consent, sociodemographic data were collected, including age, sex, education level, occupation, and religion. Participants then completed an interviewer-administered structured questionnaire designed to assess their willingness to donate bone for allografting in the event that they themselves required hip replacement surgery. The questionnaire also explored willingness to receive a bone allograft in the context of bone defect management, as well as potential reasons for refusal, such as philosophical considerations, fear of trafficking, expectations of financial compensation, concerns about disease transmission, and doubts regarding efficacy This structured questionnaire comprising 24 items was specifically developed for this study, based on a comprehensive literature review on organ and tissue donation. The instrument was reviewed by three independent experts in orthopaedics and public health to ensure face validity, then pilot-tested with 20 volunteers (not included in the final sample) to assess clarity and cultural appropriateness. Minor adjustments were made accordingly then the questionnaire was subsequently translated into both English and French to ensure accessibility. The study protocol was approved by the relevant national ethics committees in each participating country. Participation was voluntary, and anonymity was preserved through de-identification of data. The main variables of interest were: Prevalence of willingness to donate, prevalence of willingness to accept bone allograft transplantation, stated reasons for refusal. Data analysis was performed sequentially using descriptive, univariate, and multivariate approaches. Descriptive results were expressed as counts and percentages. Univariate analyses were conducted using Chi-square or Fisher’s exact tests, as appropriate. Variables with p < 0.20 in univariate analysis were included in multivariate logistic regression models to identify factors associated with willingness to donate or accept bone allografts. Multicollinearity was assessed using the Variance Inflation Factor (VIF), with a threshold of < 5. The best-fitting model was selected based on deviance statistics and the Likelihood Ratio Test (LRT). All statistical tests were two-sided, and a p-value < 0.05 was considered significant. Analyses were conducted using IBM SPSS Statistics, version 29.0.2.0 (IBM Corp., Armonk, NY, USA). Results The study population comprised 600 participants, with a mean age of 36.2 years (SD: 11.50; range: 18–81). There were 388 men (64.5%) and 212 women (35.3%). Slightly more than half of the participants, 336 (56%), had a university-level education. Sixty participants (10%) were unemployed, 133 (22.2%) were students, and 106 (17.7%) were employed in the informal sector. Christianity was the most common religion, reported by 393 participants (65.5%), followed by Islam with 104 (17.3%). Additionally, 70 participants (11.7%) identified as animists, and 33 (5.5%) were Jehovah’s Witnesses. Detailed sociodemographic characteristics by country are presented in Table 1 . Table 1 Detailed sociodemographic characteristics by country Countries Age Sexe Education_Level Occupation Religion Cameroon n = 200 Mean :38.37 SD :11.540 Min : 20 Max : 81 M:142(71%) W:58(29%) None: 18(9%) Primary: 26(13%) Secondary: 40(20%) Universitary:116(58%) Public service :48(24%) Private service :40(20%) Informal :47(23.5%) Students :27(13.5%) Housewife :16(8%) Unemployed :22(11%) Christian :123(61.5%) Muslim:39(19.5%) Jehova_witness:11(5.5%) Animist & others:27(13.5%) Côte d’Ivoire n = 200 Mean :37.52 SD :10.488 Min : 19 Max : 76 M:131(65.5%) W:69(34.5%) None:30(15%) Primary:28(14%) Secondary:39(19.5%) Universitary:103(51.5%) Public service :69(34.5%) Private service31(15.5%) Informal :51(25.5%) Student :27(13.5%) Housewife : 11(5.5%) Unemployed :11(5.5%) Christian:115(57.5%) Muslim:53(26.5%) Jehova_witness:6(5%) Animist & others:26(13%) DRC n = 200 Mean :32.68 SD:11.738 Min : 18 Max : 72 M:115(57.5%) W:85(42.5%) None: 16(8%) Primary: 1(.5%) Secondary: 66(33%) Universitary:117(58.5%) Public_service :33(15.5%) Private_service :37(18.5%) Informal :8(4%) Student :79(39.5%) Housewife :16(8%) Unemployed :27(13.5%) Christian:155(77.5%) Muslim:12(6%) Jehova_witness:16(8%) Animist & others:17(8.5%) All Countries together N = 600 Mean :36.20 SD:11.501 Min : 18 Max :81 M:388(64.7%) W:212(35.3%) None : 64(10.7%) Primary: 55(9.2%) Secondary: 145(24.2%) Universitary :336(56%) Public_service :150(25%) Private_service :108(18%) Informal :106(17.7%) Student :133(22.2%) Housewife :43(7.2%) Unemployed :60(10%) Christian:393(65.5%) Muslim:104(17.3%) Jehova_witness:33(5.5%) Animist & others:70(11.7%) The overall prevalence of willingness to donate bone allografts was 72.5%. Specifically, it was 75.5% in Cameroon, 82.5% in CIV, and 59.5% in DRC, the latter representing the lowest rate. Across the study population, the main reasons for refusing bone allograft donation were philosophical beliefs and personal convictions (100 participants; 16.5%), fear of an organ trafficking network (105 participants; 17.5%) and requests for financial compensation (60 participants; 10%). Bone allograft donation consent rates and the various reasons for refusal by country are presented in Table 2 . Table 2 Consent to bone allograft donation and reasons for refusal Countries Donation consent Reasons for refusal Cameroon n = 200 Yes:151(75.5%) No:49(24.5%) Philosophic reasons: 28(14%) Organ traffic fear: 26(13%) Remuneration request: 11(5.5%) No reasons: 3(1.5%) Côte d’Ivoire n = 200 Yes:165(82.5%) No:51(25.5%) Philosophic reasons: 18(9.0%) Organ traffic fear: 13(6.5%) Remuneration request: 15(7.5%) No reasons: 3(1.5%) DRC n = 200 Yes:119(59.5%) No:81(40.5%) Philosophic reasons: 54(27.0%) Organ traffic fear: 66(33%) Remuneration request: 34(17%) No reasons: 2(1%) All Countries together N = 600 Yes:435(72.5%) No:165(27.5%) Philosophic reasons: 100(16.5%) Organ traffic fear: 105(17.5%) Remuneration request: 60(10%) No reasons: 8(1.3%) The overall prevalence of willingness to accept bone transplantation was 72.8%, with 76.0% in Cameroon, 74.5% in Côte d’Ivoire, and 68.0% in the DRC. The main reasons for refusal were philosophical beliefs and personal convictions (99 participants;16.5%), followed by fear of diseases transmission (71 participants;11.8%) and doubts regarding the effectiveness of the therapeutic approach (84 participants;14.0%). These reasons for refusal varied considerably between countries: in Cameroon, fear of transmissible diseases was most frequent (28 participants;14.0%); in Côte d’Ivoire, philosophical reasons predominated (28 participants;14.0%); and in the DRC, fear of organ trafficking (48 participants;24.0%) was the leading concern. Acceptance rates and reasons for refusal by country are detailed in Table 3 . Table 3 Consent to bone allograft transplantation and reasons for refusal. Countries Transplantation consent Reasons for refusal Cameroon n = 200 Yes:152(76%) No:48(24%) Philosophic reasons: 27(13.5%) Organ traffic fear: 15(7.5%) Effectiveness doubt: 21(10.5%) Disease’s transmission fear: 28(14%) Côte d’Ivoire n = 200 Yes:149(74.5%) No:51(25.5%) Philosophic reasons: 28(14%) Organ traffic fear: 8(4%) Effectiveness doubt: 21(10.5%) Disease’s transmission fear: 9(4.5%) DRC n = 200 Yes:136(68%) No:64(32%) Philosophic reasons: 44(22%) Organ traffic fear: 48(24%) Effectiveness doubt: 42(21%) Disease’s transmission fear: 47(23.5%) All Countries together N = 600 Yes:437(72.8%) No:163(27.2%) Philosophic reasons: 99(16.5%) Organ traffic fear: 71(11.8%) Effectiveness doubt: 84(14%) Disease’s transmission fear: 84(14%) In multivariate analyses, willingness to donate bone allografts was significantly associated with country of residence (OR: 1.670; 95% CI: 1.306–2.136; p < 0.001), religious affiliation (OR: 0.513; 95% CI: 0.429–0.614; p < 0.001) (Fig. 2 ), and occupation (OR: 0.858; 95% CI: 0.760–0.968; p = 0.013). Regarding transplantation acceptance, significant associations were observed with country of origin (OR: 1.282; 95% CI: 1.020–1.612; p = 0.034) and religious affiliation (OR: 0.732; 95% CI: 0.619–0.866; p < 0.001) (Table 4 ). Table 4 Multivariate analysis of factors associated with donation/transplantation Variables OR 95%CI P-value Donation consent Country 1.670 1.306–2.136 < .001 Occupation .858 .760 − .968 .013 Religion .513 .429 − .614 < .001 Transplantation consent Country 1.282 1.020–1.612 .034 Occupation 1.001 .893–1.122 .986 Religion .732 .619 − .866 < .001 Discussion This multicountry survey conducted in Cameroon, CIV, and the DRC provides novel insights into public perceptions of bone allograft donation and transplantation in sub-Saharan Africa. We observed a relatively high levels of willingness to donate (72.5%) and to accept (72.8%) bone allografts overall. However, a substantial heterogeneity across countries was observed, with higher acceptance in CIV and Cameroon compared to the DRC. Religious affiliation, professional status, and country of residence emerged as independent predictors of donation consent, while transplantation acceptance was primarily influenced by religion and country of origin. The main barriers to consent were philosophical or spiritual considerations, fear of trafficking, concerns about transmissible diseases, and doubts about therapeutic efficacy. Our results are quite similar to data from Europe and the United States, where willingness to donate organs and tissues often vary between 70–80% [ 18 , 19 ] and higher than rates reported in the Middle East where it varies between 42–62.8% [ 8 ]. However, willingness does not always translate into actual donation as describe in this study showing that, in the United States, rural communities demonstrate strong willingness to donate but remain underrepresented in donor registries [ 22 ]. This paradox mirrors the subsaharian-africa context, where enthusiasm may be counterbalanced by systemic limitations such as the absence of bone banks and widespread mistrust in healthcare institutions [ 6 , 2 ]. Religious affiliation was a strong determinant of both donation and transplantation acceptance in our sample. This echoes similar reports from the Middle East and in Turkish, where studies have demonstrated that Islamic beliefs and interpretations significantly influence organ and tissue donation decisions, often resulting in lower acceptance rates compared to Western contexts [ 13 , 15 ]. In our study, animist and minority religious groups such as Jehovah's Witnesses expressed lower levels of acceptance, this is similar to observation made on blood donation studies where animist were afraid of ritualistic use of their blood [ 6 ]. Christianity was associated with higher donation acceptance, aligning with prior findings that religious endorsement of donation can serve as a facilitator [ 13 ]. Mistrust in healthcare institutions emerged as a recurring barrier, particularly in the DRC, where fear of organ trafficking was pronounced. Comparable patterns have been documented elsewhere. Similar studies in Turkey, Kazakhstan and Saudi Arabia showed that distrust in the medical system, fear of misuse, skepticism and concerns regarding system transparency substantially reduced donation willingness [ 5 , 14 , 17 ]. These parallels suggest that trust-building measures are indispensable in fostering acceptance of allograft donation. The socioeconomic determinants observed in our study, such as reduced willingness among unemployed individuals, are consistent with findings from Latin America, where lower socioeconomic status was associated with more reservations toward donation [ 21 ]. This underscores the need for tailored educational campaigns that not only address religious and cultural concerns but also consider the economic and informational vulnerabilities of specific groups. Encouraging precedent comes from other low-income and emerging countries where bone banking systems have been implemented. In Nigeria, Alatishe et al. recently reported the outcomes of the first two years of bone banking, demonstrating feasibility and cultural acceptability [ 2 ], while their follow-up study on 28 clinical cases further confirmed the therapeutic relevance of stored bone allografts [ 3 ]. Comparable experiences have been reported in Pakistan [ 4 ] and India [ 20 ], where bone banks were successfully integrated into tertiary care hospitals despite initial logistic and cultural barriers. These examples demonstrate that, when adapted to local contexts, bone banking can be implemented in resource-limited settings and can significantly improve access to musculoskeletal reconstruction. They highlight that successful bone banking in resource-limited settings requires more than technical capacity. Addressing logistical barriers (cold-chain transport, sterilization, traceability), establishing clear governance and ethical oversight, and training local staff in procurement and processing were essential to their implementation. Translating expressed willingness into effective donation also demands concrete measures, such as transparent standard operating procedures, public awareness campaigns tailored to local beliefs, active engagement of community and religious leaders, and robust monitoring systems to ensure safety and trust. Similar multifaceted strategies may be needed in sub-Saharan Africa to convert the favorable attitudes observed in this study into sustained donation and transplantation practices. Several limitations should be acknowledged. Firstly, the study did not explore donation intentions in the context of death, as the authors adopted a stepwise approach to better capture local customs. The issue of deceased donors should be addressed in future research. Another limitation is the absence of a qualitative component, such as in-depth interviews or focus groups, which could have provided richer insights into the cultural and spiritual beliefs underlying donation decisions. In addition, responses may have been influenced by social desirability bias, as participants might have overstated their willingness to donate or receive allografts in order to align with perceived expectations. Finally, the perceptions of healthcare professionals toward bone banking were not investigated, although their engagement is essential for the effective development and utilization of bone allograft programs. Conclusion Our study highlights both promising opportunities and persistent challenges for the development of bone banking in sub-Saharan Africa. The relatively high willingness to donate and receive allografts, comparable to rates in high-income regions, suggests a favorable foundation for future programs. Nevertheless, systemic deficiencies, mistrust of healthcare systems, cultural and religious concerns remain significant barriers. Addressing these obstacles will require not only technical infrastructure but also transparent governance, culturally sensitive education, and active community engagement to foster trust and dispel misconceptions. The support and involvement of healthcare professionals and policymakers will also be critical to ensure ethical practices and the sustainable integration of bone banking into national health systems. Declarations No funds, grants, or other support was received. The authors have no competing interests to declare that are relevant to the content of this article. D eclaration of Generative AI and AI-assisted technologies in the writing process : During the preparation of this work, the author(s) used ChatGPT (OpenAI, San Francisco, CA) in order to assist with language refinement. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication. Author contributions The authors' specific contributions to this work are detailed below, in accordance with the CRediT (Contributor Roles Taxonomy) guidelines: CD, RBM & AANK: Conceptualization; Investigation; Writing – original draft; Visualization; Project administration. AANK, ACM, SN, RN, JM: Investigation GF, CD: Formal analysis; Methodology; Data curation; Writing – original draft; Writing – review & editing. LF, FB, PLD, TS: Validation; Writing – review & editing. OC: Conceptualization; Methodology; Supervision; Writing – review & editing. Acknowledgement We gratefully acknowledge the staff of the Musculoskeletal Tissue and Cell Therapy Unit, Cliniques Universitaires Saint-Luc (Brussels, Belgium), for their assistance and collaboration throughout the preparation of this study. References Abdoli M, Scotto Rosato M, Desousa A, Cotrufo P. Cultural Differences in Body Image: A Systematic Review. 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Cite Share Download PDF Status: Published Journal Publication published 13 Mar, 2026 Read the published version in Cell and Tissue Banking → Version 1 posted Editorial decision: Revision requested 01 Dec, 2025 Reviews received at journal 19 Nov, 2025 Reviews received at journal 06 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers invited by journal 04 Nov, 2025 Editor assigned by journal 06 Oct, 2025 Submission checks completed at journal 06 Oct, 2025 First submitted to journal 03 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":16026,"visible":true,"origin":"","legend":"\u003cp\u003eflowchart of participants recruitment in each country.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7774926/v1/78ae472d0d6cbe9dcfb1e08c.png"},{"id":95895384,"identity":"6a3cc65a-bdc7-44cf-9765-6be31ba627c6","added_by":"auto","created_at":"2025-11-14 07:12:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25062,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of donation consent according to religion.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7774926/v1/ea006b0fc03980dfce14ced2.png"},{"id":104739671,"identity":"8dacf97d-3b3a-4266-89b9-27107738737b","added_by":"auto","created_at":"2026-03-16 16:11:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":678110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7774926/v1/1696615b-5d36-492c-9799-e3652d2d298d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Willingness to Bone Allograft Donation and Transplantation in Sub-Saharan Africa: A Multi-Country Cross- Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eVarious infectious, neoplastic, degenerative or complex traumatic conditions of the musculoskeletal system can lead to critical bone loss during their course [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Management often requires the integration of bone defect reconstruction techniques into the therapeutic strategy. Bone is therefore the second most frequently transplanted human tissue worldwide, with 2.2\u0026nbsp;million bone grafts being performed each year [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, any initiative aimed at acquiring and/or using bone allografts relies on an essential prerequisite: donor and/or the receiver consent. Such consent may be influenced by diverse cultural, philosophical, and spiritual beliefs [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Sub-Saharan Africa is characterized by considerable ethnic and cultural diversity, coupled with heterogeneous philosophical and religious perspectives, as well as significant discrepancies in terms of education and financial income [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The perception of the human body is therefore very variable from one area to another [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Consequently, the attitudes of populations in this region toward bone allograft donation remain difficult to predict.\u003c/p\u003e\u003cp\u003eThis study aims to lay the groundwork for the creation of bone banking units in Cameroon, Democratic Republic of Congo and C\u0026ocirc;te d\u0026rsquo;Ivoire, by characterizing the profile of potential donors within this multicultural context, taking into account local beliefs and practices. It also seeks to identify potential causes of refusal, which could serve as focal points for awareness campaigns designed to increase public acceptance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional survey was conducted from January to December 2024 simultaneously in three sub-Saharan African countries: Democratic Republic of Congo (DRC), Cameroon, and Republic of C\u0026ocirc;te d\u0026rsquo;Ivoire (CIV). The study was designed to assess public perceptions and willingness to donate or receive bone allografts in the context of hip replacement surgery.\u003c/p\u003e\u003cp\u003eA total of 600 participants were enrolled, with 200 from each country Participants were recruited using a stratified convenience sampling approach. Strata were defined by country, setting (urban vs. rural), and recruitment site (hospitals, marketplaces, universities, and community gathering points) to capture socio-demographic diversity. Within each stratum, individuals who met eligibility criteria and consented to participate were enrolled consecutively until the target sample size of 200 per country was achieved. Eligible participants were adults aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years who were residents of the study area and able to provide informed consent. Individuals with cognitive impairment preventing questionnaire comprehension, as well as non-residents or visitors, were excluded. Non-responses and refusals were recorded and replaced. The response rate was calculated as the number of completed questionnaires divided by the number of eligible individuals approached (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTrained interviewers approached eligible participants and provided them with an information sheet describing a hypothetical scenario of hip replacement surgery. Following the provision of written informed consent, sociodemographic data were collected, including age, sex, education level, occupation, and religion. Participants then completed an interviewer-administered structured questionnaire designed to assess their willingness to donate bone for allografting in the event that they themselves required hip replacement surgery. The questionnaire also explored willingness to receive a bone allograft in the context of bone defect management, as well as potential reasons for refusal, such as philosophical considerations, fear of trafficking, expectations of financial compensation, concerns about disease transmission, and doubts regarding efficacy This structured questionnaire comprising 24 items was specifically developed for this study, based on a comprehensive literature review on organ and tissue donation. The instrument was reviewed by three independent experts in orthopaedics and public health to ensure face validity, then pilot-tested with 20 volunteers (not included in the final sample) to assess clarity and cultural appropriateness. Minor adjustments were made accordingly then the questionnaire was subsequently translated into both English and French to ensure accessibility.\u003c/p\u003e\u003cp\u003eThe study protocol was approved by the relevant national ethics committees in each participating country. Participation was voluntary, and anonymity was preserved through de-identification of data.\u003c/p\u003e\u003cp\u003eThe main variables of interest were: Prevalence of willingness to donate, prevalence of willingness to accept bone allograft transplantation, stated reasons for refusal.\u003c/p\u003e\u003cp\u003eData analysis was performed sequentially using descriptive, univariate, and multivariate approaches. Descriptive results were expressed as counts and percentages. Univariate analyses were conducted using Chi-square or Fisher\u0026rsquo;s exact tests, as appropriate. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in univariate analysis were included in multivariate logistic regression models to identify factors associated with willingness to donate or accept bone allografts. Multicollinearity was assessed using the Variance Inflation Factor (VIF), with a threshold of \u0026lt;\u0026thinsp;5. The best-fitting model was selected based on deviance statistics and the Likelihood Ratio Test (LRT). All statistical tests were two-sided, and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. Analyses were conducted using IBM SPSS Statistics, version 29.0.2.0 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study population comprised 600 participants, with a mean age of 36.2 years (SD: 11.50; range: 18\u0026ndash;81). There were 388 men (64.5%) and 212 women (35.3%). Slightly more than half of the participants, 336 (56%), had a university-level education. Sixty participants (10%) were unemployed, 133 (22.2%) were students, and 106 (17.7%) were employed in the informal sector. Christianity was the most common religion, reported by 393 participants (65.5%), followed by Islam with 104 (17.3%). Additionally, 70 participants (11.7%) identified as animists, and 33 (5.5%) were Jehovah\u0026rsquo;s Witnesses. Detailed sociodemographic characteristics by country are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDetailed sociodemographic characteristics by country\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSexe\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEducation_Level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCameroon\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026nbsp;:38.37\u003c/p\u003e\u003cp\u003eSD\u0026nbsp;:11.540\u003c/p\u003e\u003cp\u003eMin\u0026nbsp;: 20\u003c/p\u003e\u003cp\u003eMax\u0026nbsp;: 81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM:142(71%)\u003c/p\u003e\u003cp\u003eW:58(29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone: 18(9%)\u003c/p\u003e\u003cp\u003ePrimary: 26(13%)\u003c/p\u003e\u003cp\u003eSecondary: 40(20%)\u003c/p\u003e\u003cp\u003eUniversitary:116(58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePublic service\u0026nbsp;:48(24%)\u003c/p\u003e\u003cp\u003ePrivate service\u0026nbsp;:40(20%)\u003c/p\u003e\u003cp\u003eInformal\u0026nbsp;:47(23.5%)\u003c/p\u003e\u003cp\u003eStudents\u0026nbsp;:27(13.5%)\u003c/p\u003e\u003cp\u003eHousewife\u0026nbsp;:16(8%)\u003c/p\u003e\u003cp\u003eUnemployed\u0026nbsp;:22(11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChristian\u0026nbsp;:123(61.5%)\u003c/p\u003e\u003cp\u003eMuslim:39(19.5%)\u003c/p\u003e\u003cp\u003eJehova_witness:11(5.5%)\u003c/p\u003e\u003cp\u003eAnimist \u0026amp; others:27(13.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC\u0026ocirc;te d\u0026rsquo;Ivoire\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026nbsp;:37.52\u003c/p\u003e\u003cp\u003eSD\u0026nbsp;:10.488\u003c/p\u003e\u003cp\u003eMin\u0026nbsp;: 19\u003c/p\u003e\u003cp\u003eMax\u0026nbsp;: 76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM:131(65.5%)\u003c/p\u003e\u003cp\u003eW:69(34.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone:30(15%)\u003c/p\u003e\u003cp\u003ePrimary:28(14%)\u003c/p\u003e\u003cp\u003eSecondary:39(19.5%)\u003c/p\u003e\u003cp\u003eUniversitary:103(51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePublic service\u0026nbsp;:69(34.5%)\u003c/p\u003e\u003cp\u003ePrivate service31(15.5%)\u003c/p\u003e\u003cp\u003eInformal\u0026nbsp;:51(25.5%)\u003c/p\u003e\u003cp\u003eStudent\u0026nbsp;:27(13.5%)\u003c/p\u003e\u003cp\u003eHousewife\u0026nbsp;: 11(5.5%)\u003c/p\u003e\u003cp\u003eUnemployed\u0026nbsp;:11(5.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChristian:115(57.5%)\u003c/p\u003e\u003cp\u003eMuslim:53(26.5%)\u003c/p\u003e\u003cp\u003eJehova_witness:6(5%)\u003c/p\u003e\u003cp\u003eAnimist \u0026amp; others:26(13%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDRC\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026nbsp;:32.68\u003c/p\u003e\u003cp\u003eSD:11.738\u003c/p\u003e\u003cp\u003eMin\u0026nbsp;: 18\u003c/p\u003e\u003cp\u003eMax\u0026nbsp;: 72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM:115(57.5%)\u003c/p\u003e\u003cp\u003eW:85(42.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone: 16(8%)\u003c/p\u003e\u003cp\u003ePrimary: 1(.5%)\u003c/p\u003e\u003cp\u003eSecondary: 66(33%)\u003c/p\u003e\u003cp\u003eUniversitary:117(58.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePublic_service\u0026nbsp;:33(15.5%)\u003c/p\u003e\u003cp\u003ePrivate_service\u0026nbsp;:37(18.5%)\u003c/p\u003e\u003cp\u003eInformal\u0026nbsp;:8(4%)\u003c/p\u003e\u003cp\u003eStudent\u0026nbsp;:79(39.5%)\u003c/p\u003e\u003cp\u003eHousewife\u0026nbsp;:16(8%)\u003c/p\u003e\u003cp\u003eUnemployed\u0026nbsp;:27(13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChristian:155(77.5%)\u003c/p\u003e\u003cp\u003eMuslim:12(6%)\u003c/p\u003e\u003cp\u003eJehova_witness:16(8%)\u003c/p\u003e\u003cp\u003eAnimist \u0026amp; others:17(8.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll Countries together\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026nbsp;:36.20\u003c/p\u003e\u003cp\u003eSD:11.501\u003c/p\u003e\u003cp\u003eMin\u0026nbsp;: 18\u003c/p\u003e\u003cp\u003eMax\u0026nbsp;:81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM:388(64.7%)\u003c/p\u003e\u003cp\u003eW:212(35.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone : 64(10.7%)\u003c/p\u003e\u003cp\u003ePrimary: 55(9.2%)\u003c/p\u003e\u003cp\u003eSecondary: 145(24.2%)\u003c/p\u003e\u003cp\u003eUniversitary :336(56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePublic_service\u0026nbsp;:150(25%)\u003c/p\u003e\u003cp\u003ePrivate_service\u0026nbsp;:108(18%)\u003c/p\u003e\u003cp\u003eInformal\u0026nbsp;:106(17.7%)\u003c/p\u003e\u003cp\u003eStudent\u0026nbsp;:133(22.2%)\u003c/p\u003e\u003cp\u003eHousewife\u0026nbsp;:43(7.2%)\u003c/p\u003e\u003cp\u003eUnemployed\u0026nbsp;:60(10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChristian:393(65.5%)\u003c/p\u003e\u003cp\u003eMuslim:104(17.3%)\u003c/p\u003e\u003cp\u003eJehova_witness:33(5.5%)\u003c/p\u003e\u003cp\u003eAnimist \u0026amp; others:70(11.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe overall prevalence of willingness to donate bone allografts was 72.5%. Specifically, it was 75.5% in Cameroon, 82.5% in CIV, and 59.5% in DRC, the latter representing the lowest rate. Across the study population, the main reasons for refusing bone allograft donation were philosophical beliefs and personal convictions (100 participants; 16.5%), fear of an organ trafficking network (105 participants; 17.5%) and requests for financial compensation (60 participants; 10%). Bone allograft donation consent rates and the various reasons for refusal by country are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eConsent to bone allograft donation and reasons for refusal\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDonation consent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReasons for refusal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCameroon\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:151(75.5%)\u003c/p\u003e\u003cp\u003eNo:49(24.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 28(14%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 26(13%)\u003c/p\u003e\u003cp\u003eRemuneration request: 11(5.5%)\u003c/p\u003e\u003cp\u003eNo reasons: 3(1.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC\u0026ocirc;te d\u0026rsquo;Ivoire\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:165(82.5%)\u003c/p\u003e\u003cp\u003eNo:51(25.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 18(9.0%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 13(6.5%)\u003c/p\u003e\u003cp\u003eRemuneration request: 15(7.5%)\u003c/p\u003e\u003cp\u003eNo reasons: 3(1.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDRC\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:119(59.5%)\u003c/p\u003e\u003cp\u003eNo:81(40.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 54(27.0%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 66(33%)\u003c/p\u003e\u003cp\u003eRemuneration request: 34(17%)\u003c/p\u003e\u003cp\u003eNo reasons: 2(1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll Countries together\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:435(72.5%)\u003c/p\u003e\u003cp\u003eNo:165(27.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 100(16.5%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 105(17.5%)\u003c/p\u003e\u003cp\u003eRemuneration request: 60(10%)\u003c/p\u003e\u003cp\u003eNo reasons: 8(1.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe overall prevalence of willingness to accept bone transplantation was 72.8%, with 76.0% in Cameroon, 74.5% in C\u0026ocirc;te d\u0026rsquo;Ivoire, and 68.0% in the DRC. The main reasons for refusal were philosophical beliefs and personal convictions (99 participants;16.5%), followed by fear of diseases transmission (71 participants;11.8%) and doubts regarding the effectiveness of the therapeutic approach (84 participants;14.0%). These reasons for refusal varied considerably between countries: in Cameroon, fear of transmissible diseases was most frequent (28 participants;14.0%); in C\u0026ocirc;te d\u0026rsquo;Ivoire, philosophical reasons predominated (28 participants;14.0%); and in the DRC, fear of organ trafficking (48 participants;24.0%) was the leading concern. Acceptance rates and reasons for refusal by country are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eConsent to bone allograft transplantation and reasons for refusal.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransplantation consent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReasons for refusal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCameroon\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:152(76%)\u003c/p\u003e\u003cp\u003eNo:48(24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 27(13.5%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 15(7.5%)\u003c/p\u003e\u003cp\u003eEffectiveness doubt: 21(10.5%)\u003c/p\u003e\u003cp\u003eDisease\u0026rsquo;s transmission fear: 28(14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC\u0026ocirc;te d\u0026rsquo;Ivoire\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:149(74.5%)\u003c/p\u003e\u003cp\u003eNo:51(25.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 28(14%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 8(4%)\u003c/p\u003e\u003cp\u003eEffectiveness doubt: 21(10.5%)\u003c/p\u003e\u003cp\u003eDisease\u0026rsquo;s transmission fear: 9(4.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDRC\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:136(68%)\u003c/p\u003e\u003cp\u003eNo:64(32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 44(22%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 48(24%)\u003c/p\u003e\u003cp\u003eEffectiveness doubt: 42(21%)\u003c/p\u003e\u003cp\u003eDisease\u0026rsquo;s transmission fear: 47(23.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll Countries together\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes:437(72.8%)\u003c/p\u003e\u003cp\u003eNo:163(27.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhilosophic reasons: 99(16.5%)\u003c/p\u003e\u003cp\u003eOrgan traffic fear: 71(11.8%)\u003c/p\u003e\u003cp\u003eEffectiveness doubt: 84(14%)\u003c/p\u003e\u003cp\u003eDisease\u0026rsquo;s transmission fear: 84(14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn multivariate analyses, willingness to donate bone allografts was significantly associated with country of residence (OR: 1.670; 95% CI: 1.306\u0026ndash;2.136; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), religious affiliation (OR: 0.513; 95% CI: 0.429\u0026ndash;0.614; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and occupation (OR: 0.858; 95% CI: 0.760\u0026ndash;0.968; p\u0026thinsp;=\u0026thinsp;0.013). Regarding transplantation acceptance, significant associations were observed with country of origin (OR: 1.282; 95% CI: 1.020\u0026ndash;1.612; p\u0026thinsp;=\u0026thinsp;0.034) and religious affiliation (OR: 0.732; 95% CI: 0.619\u0026ndash;0.866; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate analysis of factors associated with donation/transplantation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eDonation consent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.670\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.306\u0026ndash;2.136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.858\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.760 \u0026minus;\u0026thinsp;.968\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.429 \u0026minus;\u0026thinsp;.614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eTransplantation consent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.020\u0026ndash;1.612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.893\u0026ndash;1.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.986\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.732\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.619 \u0026minus;\u0026thinsp;.866\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicountry survey conducted in Cameroon, CIV, and the DRC provides novel insights into public perceptions of bone allograft donation and transplantation in sub-Saharan Africa. We observed a relatively high levels of willingness to donate (72.5%) and to accept (72.8%) bone allografts overall. However, a substantial heterogeneity across countries was observed, with higher acceptance in CIV and Cameroon compared to the DRC. Religious affiliation, professional status, and country of residence emerged as independent predictors of donation consent, while transplantation acceptance was primarily influenced by religion and country of origin. The main barriers to consent were philosophical or spiritual considerations, fear of trafficking, concerns about transmissible diseases, and doubts about therapeutic efficacy.\u003c/p\u003e\u003cp\u003eOur results are quite similar to data from Europe and the United States, where willingness to donate organs and tissues often vary between 70\u0026ndash;80% [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and higher than rates reported in the Middle East where it varies between 42\u0026ndash;62.8% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, willingness does not always translate into actual donation as describe in this study showing that, in the United States, rural communities demonstrate strong willingness to donate but remain underrepresented in donor registries [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This paradox mirrors the subsaharian-africa context, where enthusiasm may be counterbalanced by systemic limitations such as the absence of bone banks and widespread mistrust in healthcare institutions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eReligious affiliation was a strong determinant of both donation and transplantation acceptance in our sample. This echoes similar reports from the Middle East and in Turkish, where studies have demonstrated that Islamic beliefs and interpretations significantly influence organ and tissue donation decisions, often resulting in lower acceptance rates compared to Western contexts [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In our study, animist and minority religious groups such as Jehovah's Witnesses expressed lower levels of acceptance, this is similar to observation made on blood donation studies where animist were afraid of ritualistic use of their blood [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Christianity was associated with higher donation acceptance, aligning with prior findings that religious endorsement of donation can serve as a facilitator [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMistrust in healthcare institutions emerged as a recurring barrier, particularly in the DRC, where fear of organ trafficking was pronounced. Comparable patterns have been documented elsewhere. Similar studies in Turkey, Kazakhstan and Saudi Arabia showed that distrust in the medical system, fear of misuse, skepticism and concerns regarding system transparency substantially reduced donation willingness [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These parallels suggest that trust-building measures are indispensable in fostering acceptance of allograft donation.\u003c/p\u003e\u003cp\u003eThe socioeconomic determinants observed in our study, such as reduced willingness among unemployed individuals, are consistent with findings from Latin America, where lower socioeconomic status was associated with more reservations toward donation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This underscores the need for tailored educational campaigns that not only address religious and cultural concerns but also consider the economic and informational vulnerabilities of specific groups.\u003c/p\u003e\u003cp\u003eEncouraging precedent comes from other low-income and emerging countries where bone banking systems have been implemented. In Nigeria, Alatishe et al. recently reported the outcomes of the first two years of bone banking, demonstrating feasibility and cultural acceptability [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], while their follow-up study on 28 clinical cases further confirmed the therapeutic relevance of stored bone allografts [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Comparable experiences have been reported in Pakistan [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and India [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], where bone banks were successfully integrated into tertiary care hospitals despite initial logistic and cultural barriers. These examples demonstrate that, when adapted to local contexts, bone banking can be implemented in resource-limited settings and can significantly improve access to musculoskeletal reconstruction. They highlight that successful bone banking in resource-limited settings requires more than technical capacity. Addressing logistical barriers (cold-chain transport, sterilization, traceability), establishing clear governance and ethical oversight, and training local staff in procurement and processing were essential to their implementation. Translating expressed willingness into effective donation also demands concrete measures, such as transparent standard operating procedures, public awareness campaigns tailored to local beliefs, active engagement of community and religious leaders, and robust monitoring systems to ensure safety and trust. Similar multifaceted strategies may be needed in sub-Saharan Africa to convert the favorable attitudes observed in this study into sustained donation and transplantation practices.\u003c/p\u003e\u003cp\u003eSeveral limitations should be acknowledged. Firstly, the study did not explore donation intentions in the context of death, as the authors adopted a stepwise approach to better capture local customs. The issue of deceased donors should be addressed in future research. Another limitation is the absence of a qualitative component, such as in-depth interviews or focus groups, which could have provided richer insights into the cultural and spiritual beliefs underlying donation decisions. In addition, responses may have been influenced by social desirability bias, as participants might have overstated their willingness to donate or receive allografts in order to align with perceived expectations. Finally, the perceptions of healthcare professionals toward bone banking were not investigated, although their engagement is essential for the effective development and utilization of bone allograft programs.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study highlights both promising opportunities and persistent challenges for the development of bone banking in sub-Saharan Africa. The relatively high willingness to donate and receive allografts, comparable to rates in high-income regions, suggests a favorable foundation for future programs. Nevertheless, systemic deficiencies, mistrust of healthcare systems, cultural and religious concerns remain significant barriers. Addressing these obstacles will require not only technical infrastructure but also transparent governance, culturally sensitive education, and active community engagement to foster trust and dispel misconceptions. The support and involvement of healthcare professionals and policymakers will also be critical to ensure ethical practices and the sustainable integration of bone banking into national health systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eNo funds, grants, or other support was received. The authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003eD\u003cstrong\u003eeclaration of Generative AI and AI-assisted technologies in the writing process\u003c/strong\u003e: During the preparation of this work, the author(s) used ChatGPT (OpenAI, San Francisco, CA) in order to assist with language refinement. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026apos; specific contributions to this work are detailed below, in accordance with the CRediT (Contributor Roles Taxonomy) guidelines:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCD, RBM \u0026amp; AANK:\u0026nbsp;\u003c/strong\u003eConceptualization; Investigation; Writing \u0026ndash; original draft; Visualization; Project administration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;AANK, ACM, SN, RN, JM:\u0026nbsp;\u003c/strong\u003eInvestigation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGF, CD:\u003c/strong\u003e Formal analysis; Methodology; Data curation; Writing \u0026ndash; original draft; Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLF, FB, PLD, TS:\u0026nbsp;\u003c/strong\u003eValidation; Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOC:\u0026nbsp;\u003c/strong\u003eConceptualization; Methodology; Supervision; Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe gratefully acknowledge the staff of the Musculoskeletal Tissue and Cell Therapy Unit, Cliniques Universitaires Saint-Luc (Brussels, Belgium), for their assistance and collaboration throughout the preparation of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbdoli M, Scotto Rosato M, Desousa A, Cotrufo P. 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PMID: 40255675; PMCID: PMC12009056.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cell-and-tissue-banking","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"catb","sideBox":"Learn more about [Cell and Tissue Banking](http://link.springer.com/journal/10561)","snPcode":"10561","submissionUrl":"https://submission.nature.com/new-submission/10561/3","title":"Cell and Tissue Banking","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bone allograft, Tissue donation, transplantation consent, Sub-Saharan Africa, Bone banks","lastPublishedDoi":"10.21203/rs.3.rs-7774926/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7774926/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground.\u003c/h2\u003e\u003cp\u003eBone is the second most frequently transplanted human tissue worldwide, with 2.2\u0026nbsp;million grafts performed annually. In sub-Saharan Africa, donor and recipient consent remains uncertain due to diverse cultural, religious, and socioeconomic contexts. This study assessed public attitudes toward bone allograft donation and transplantation in Cameroon, C\u0026ocirc;te d\u0026rsquo;Ivoire, and the Democratic Republic of Congo to support the planning and implementation of bone banks.\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e\u003cp\u003eA multicountry cross-sectional survey was conducted between January and December 2024. Six hundred adults (200 per country) were recruited through stratified convenience sampling in urban and rural settings. After informed consent, participants completed an interviewer-administered questionnaire capturing sociodemographic data, willingness to donate and receive bone allografts, and reasons for refusal. Descriptive statistics, univariate and multivariate logistic regression identified predictors of willingness.\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e\u003cp\u003eThe cohort (mean age 36.2 years) reported a willingness to donate of 72.5% and transplantation acceptance of 72.8%. Refusal for donation was mainly linked to philosophical or spiritual beliefs, fear of trafficking, and remuneration request. Multivariate analysis showed that country of residence, religion, and occupation independently predicted donation, while acceptance was influenced by country and religion.\u003c/p\u003e\u003ch2\u003eConclusion.\u003c/h2\u003e\u003cp\u003eWillingness to donate and receive bone allografts in sub-Saharan Africa is relatively high and comparable to high-income regions, though heterogeneity exists between countries. Key barriers include religious convictions, mistrust of health systems, and socioeconomic vulnerabilities. Establishing bone banks will require culturally sensitive education, transparent governance, and community engagement to transform willingness into effective donation practices.\u003c/p\u003e","manuscriptTitle":"Willingness to Bone Allograft Donation and Transplantation in Sub-Saharan Africa: A Multi-Country Cross- Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 07:12:06","doi":"10.21203/rs.3.rs-7774926/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-01T13:27:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T09:58:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-06T15:23:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12133503314489736362434810280454450036","date":"2025-11-06T11:49:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263513938059175620041664940080058507073","date":"2025-11-06T09:28:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-04T09:19:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-06T07:55:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-06T07:55:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cell and Tissue Banking","date":"2025-10-03T15:53:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cell-and-tissue-banking","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"catb","sideBox":"Learn more about [Cell and Tissue Banking](http://link.springer.com/journal/10561)","snPcode":"10561","submissionUrl":"https://submission.nature.com/new-submission/10561/3","title":"Cell and Tissue Banking","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3e4106bd-dcf4-451e-a283-9e769e616cdc","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:07:33+00:00","versionOfRecord":{"articleIdentity":"rs-7774926","link":"https://doi.org/10.1007/s10561-026-10220-8","journal":{"identity":"cell-and-tissue-banking","isVorOnly":false,"title":"Cell and Tissue Banking"},"publishedOn":"2026-03-13 15:59:46","publishedOnDateReadable":"March 13th, 2026"},"versionCreatedAt":"2025-11-14 07:12:06","video":"","vorDoi":"10.1007/s10561-026-10220-8","vorDoiUrl":"https://doi.org/10.1007/s10561-026-10220-8","workflowStages":[]},"version":"v1","identity":"rs-7774926","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7774926","identity":"rs-7774926","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}